Objective: To evaluate outcomes of palliative surgery for malignant bowel obstruction (MBO) and identify factors associated with postoperative survival. Methods: We retrospectively reviewed 27 patients who underwent palliative surgery for MBO between April 2014 and March 2023. Clinical data including symptom relief, oral intake, discharge status, and overall survival (OS) were analyzed. Results: Median age was 70 years; 23 patients were Stage IV. Primary tumors included colon-rectum (15), stomach (6), pancreas (2), and others (4). Peritoneal dissemination was present in 18 cases. Median preoperative Palliative Prognostic Index (PPI) was 3.0. Postoperative symptom relief was achieved in 96.3%, oral intake in 81.5%, and discharge in 51.9%. Median OS was 118 days. Peritoneal dissemination and oral intake status were significantly associated with OS; sex, age, and PPI were not. Conclusion: Palliative surgery may improve outcomes such as symptom relief, oral intake, discharge to preferred care settings, and survival. These findings support its role in advance care planning and enhancing quality of life in patients with terminal cancer.

Background: This study aimed to evaluate the differences in common types of epidermal growthfactor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) with brain metastasis (BM) treated using linear accelerator-based stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT). Methods: Between January 2011–December 2023, among 294 consecutive patients with BMfrom NSCLC, 84 patients with EGFR-mutated NSCLC were enrolled in this study. Results: The median follow-up time after SRS/fSRT was 20.1 months (range: 0.6–109.7months), while the median overall survival (mOS) after SRS/fSRT was 25.1 months (95% confidence interval [CI]: 18.4–33.5 months). The mOS after initial treatment for NSCLC was 56.2 months (95% CI:41.7–77.0 months). The mOS after SRS/fSRT in 34 patients with exon 19 deletions and 45 patients with exon 21 mutations with L858R was 20.4 months (95% CI: 13.6–55.9 months) and 28.5 months (95% CI: 16.2–33.5). The two groups showed no difference in the mOS. In univariate analyses using the Cox proportional hazards model, no prognostic factors associated with prolonged survival were identified except for good pretreatment Karnofsky Performance Status score and no prior tyrosine kinase inhibitor use before SRS/fSRT in EGFR-mutated NSCLC. There was no difference in both distant failure and local control in the two groups. Conclusion The difference in survival between EGFR subtypes (exon 21 L858R mutations vs.exon 19 deletion) was not observed after SRS/fSRT in NSCLC.

Objective: We conducted two workshops to encourage “Jinsei Kaigi” to discuss advance care planning (ACP) with family members or significant others during healthy times and evaluated whether the workshops were effectively motivated participants to engage in ACP. Methods: Two workshops were held with 171 welfare commissioners, and four surveys were conducted (T1-T4) before and after the workshops. The primary endpoint was the rate of “Jinsei Kaigi” implementation, and the secondary endpoints were the Japanese versions of the ACP Engagement Survey (ACPES-J), which measures readiness for ACP, and Death Attitude Inventory (DAI), which were compared before and after the intervention, with T1 VS. T4 as the primary analysis. Results: A total of 149 participants were analyzed, and the implementation rate was 38.3%, which was a significant increase from 6% before implementation (p<.001, w=.54). Self-efficacy, readiness, and ACPES-J total scores increased significantly (p<.001 to .031, d=.29 to .67, respectively), but there were no significant changes in DAI. Conclusion: Our results suggest that workshops provide opportunities to motivate engagement in “Jinsei Kaigi”.

Objective·To identify different comorbidity types resulting from the spontaneous association of psychopathological symptoms among male drug addicts,explore the relationship between latent types and drug addiction,and examine the mediating role of psychological distress.Methods·Four hundred and fifty male drug addicts,recruited by Yunnan First Compulsory Isolation Drug Rehabilitation Center according to the 2017 revised Drug Addiction Identification Method by the Ministry of Public Security,were enrolled as participants.The Symptom Checklist-90(SCL-90),Craving Automated Scale for Substances(CAS-S),and Psychache Scale(PAS)were used to assess the severity of psychopathological symptoms,drug addiction,and psychological distress,respectively.Latent class analysis was employed to identify different types of psychopathological comorbidity that may exist in the participants,and the types were named based on the analysis results.Variance analysis was used to test differences in the severity of drug addiction and psychological distress among different latent types,and a mediation model was established to explore the mediating role of psychological distress between different latent types and drug addiction.Results·Latent class analysis identified three types of psychopathology:high,medium,and low levels,with decreasing positive rates and numbers of comorbidity in each type based on the ten psychopathological symptoms included in the SCL-90.There were significant differences in the severity of psychological distress and drug addiction among the three types of participants.Psychopathological symptoms positively predicted the severity of psychological distress and drug addiction.Psychological distress completely mediated the relationship between medium levels of psychopathology and drug addiction,while partially mediating the relationship between high levels of psychopathology and drug addiction.Conclusion·There are three types of psychopathological comorbidity among male drug addicts:high,medium,and low.Psychological distress plays a complete mediating role between medium levels of psychopathology and drug addiction,and a partial mediating role between high levels of psychopathology and drug addiction.

We report a case of persistent pain in a 21-year-old male patient, which responded well to yokukansan and keishikaryukotsuboreito, after biopsy surgery performed 5 years ago. Chronic postsurgical pain (CPSP) is a condition in which pain persists even after the surgical wound has healed, significantly affecting the patient’s daily life and mental state. Our patient was diagnosed with fibrous osteodysplasia based on a biopsy of the sacral region, but his postoperative pain persisted and became chronic. The patient’s activities of daily living (ADL) significantly declined, and he was unable to maintain a normal school life. Simultaneous treatment with shigyakusan, keishibukuryogankayokuinin, tramadol hydrochloride, and acetaminophen was started, and the medication was repeatedly changed. His quality of life notably improved with yokukansan and keishikaryukotsuboreito. In recent years, there have been many reports of the use of yokukansan for chronic pain, and the results of our case suggest that the addition of the anxiolytic and analgesic effects of keishikaryukotsuboreito is effective for intractable chronic pain.

In this study, we conducted interviews with staff members who had experience in discharge coordination to clarify the characteristics and efforts of discharge coordination for patients with pediatric cancer toward end-of-life. Focus group interviews were conducted with 11 individuals, including six medical social workers and five nurses (acceptance rate: 84.6%) and a qualitative inductive analysis was conducted. Seven categories were identified as characteristics of discharge coordination for patients with pediatric cancer toward the end-of-life, such as “few home physicians and home health care nurses who could accept terminally ill children” and “a small number of cases and lack of accumulated experience”. Seven categories were identified as efforts of discharge coordination, including “maintaining connections with the community” in three situations: coordination with home physicians and home-visit nursing care, coordination with children and their families, and coordination in hospitals. The number of children who spend their end-of-life days at home is increasing, and we believe that it is necessary to consider expanding the role of pediatric cancer base hospitals in the future, such as collecting information in the community and sharing good practices.

We report a new risk stratification of invasive stage papillary thyroid carcinomas (PTCs) by combining invasive status, using extrathyroid invasion (Ex) status, and tumor growth speed using the Ki-67 labeling index (LI). Methods: We examined tumor recurrence in 167 patients with PTC who were surgically treated at the Kindai University Nara Hospital between 2010 and 2022. The patients were classified according to the degree of invasion [negative (Ex0) or positive (Ex1, Ex2, and Ex3)] and tumor growth speed expressed with Ki-67 LI, as low (<5%) or high (>5%). This study confirmed previous findings that the disease-free survival (DFS) rate in PTCs significantly differed between patients with a high and low Ki-67 index. Results: When combining Ex status (negative or positive) and Ki-67 proliferation status (low or high), the DFS rate of invasion in the negative, low Ki-67 LI group was only 1.1%, while that of invasion in the positive, high Ki-67 LI was 44.1%. This study reports for the first time that recurrence risks can be stratified accurately when combining carcinoma’s essential two features of extrathyroid invasion status and tumor growth speed. Conclusions: We believe the evidence for low tumor recurrence risk may contribute to use of more conservative treatment options for invasive-stage PTCs and help alleviate patient anxiety about tumor recurrence and death.